open access

Vol 72, No 4 (2021)
Original paper
Submitted: 2021-01-24
Accepted: 2021-03-18
Early publication date: 2021-04-08
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Parathyroid hormone serum concentration kinetic profile in critically ill patients undergoing continuous renal replacement therapies: a prospective observational study

Aneta Czarnik1, Ryszard Gawda2, Maciej Piwoda2, Maciej Marszalski2, Maciej Molsa3, Marek Pietka3, Marek Bolanowski4, Tomasz Czarnik2
DOI: 10.5603/EP.a2021.0034
·
Pubmed: 34010434
·
Endokrynol Pol 2021;72(4):329-335.
Affiliations
  1. Department of Endocrinology, Voivodeship Hospital in Opole, Opole, Poland
  2. Department of Anaesthesiology, Intensive Care and Regional ECMO Centre, Institute of Medical Sciences, University of Opole, Opole, Poland
  3. Department of Anaesthesiology, Intensive Care and Regional ECMO Centre, Opole University Hospital, Opole, Poland
  4. Department of Endocrinology, Diabetes, and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland

open access

Vol 72, No 4 (2021)
Original Paper
Submitted: 2021-01-24
Accepted: 2021-03-18
Early publication date: 2021-04-08

Abstract

Introduction: Elevated serum parathormone (PTH) levels have been observed in acute kidney injury and are related to calcium-phosphate metabolism disturbance, decreased renal production of 1,25 dihydroxyvitamin D3, impaired renal PTH excretion, and other renal-independent factors. There are no data regarding PTH concentration kinetics in critically ill patients undergoing continuous renal replacement therapies (CRRT) in an intensive care setting. The primary objective of this study was to investigate trends in PTH serum levels in critically ill patients with multiorgan failure undergoing CRRT, by performing periodic PTH measurements in the acute phase of critical illness.

Material and methods: This was a single-centre, prospective, observational study conducted in an mixed, university-affiliated intensive care unit. Critically ill patients who fulfilled all of the following criteria were included: respiratory failure; circulatory failure; acute kidney injury treated by CRRT; and sequential organ failure assessment score (SOFA score) of 5 or more. Patients who met any of the following criteria were excluded: acute liver failure; hypercalcemia at admission (total calcium serum level > 10.6 mg/dL; total ionized calcium plasma level > 1.35 mmol/L); parathyroid gland disease; end-stage renal disease; patients undergoing therapeutic plasma exchange or extracorporeal membrane oxygenation procedures; aged under 18 years;  pregnant; and life expectancy after admission to the intensive care unit anticipated to be less than 72 hours as assessed by the investigator.

Results: Thirty patients met the inclusion criteria. A statistically significant change in PTH over time was observed (Friedman ANOVA; p = 0.0001). The post-hoc test showed a statistically significant decrease in PTH: measurements 5–8 relative to measurement 1, and measurements 4–8 relative to measurement 2 (p < 0.05). No significant correlations between 25 hydroxyvitamin D3 deficiency, age, diagnosis, SOFA score, and PTH levels were observed. A statistical test indicated that serum concentrations of PTH were significantly higher in the de novo sepsis group (p < 0.05).

Conclusions: The PTH serum concentration decreases during the course of CRRT in the majority of patients. When the course of the disease starts to be complicated by sepsis, PTH serum levels then remain high. A probable reason for this is the existence of the inflammatory state triggered by sepsis.

Abstract

Introduction: Elevated serum parathormone (PTH) levels have been observed in acute kidney injury and are related to calcium-phosphate metabolism disturbance, decreased renal production of 1,25 dihydroxyvitamin D3, impaired renal PTH excretion, and other renal-independent factors. There are no data regarding PTH concentration kinetics in critically ill patients undergoing continuous renal replacement therapies (CRRT) in an intensive care setting. The primary objective of this study was to investigate trends in PTH serum levels in critically ill patients with multiorgan failure undergoing CRRT, by performing periodic PTH measurements in the acute phase of critical illness.

Material and methods: This was a single-centre, prospective, observational study conducted in an mixed, university-affiliated intensive care unit. Critically ill patients who fulfilled all of the following criteria were included: respiratory failure; circulatory failure; acute kidney injury treated by CRRT; and sequential organ failure assessment score (SOFA score) of 5 or more. Patients who met any of the following criteria were excluded: acute liver failure; hypercalcemia at admission (total calcium serum level > 10.6 mg/dL; total ionized calcium plasma level > 1.35 mmol/L); parathyroid gland disease; end-stage renal disease; patients undergoing therapeutic plasma exchange or extracorporeal membrane oxygenation procedures; aged under 18 years;  pregnant; and life expectancy after admission to the intensive care unit anticipated to be less than 72 hours as assessed by the investigator.

Results: Thirty patients met the inclusion criteria. A statistically significant change in PTH over time was observed (Friedman ANOVA; p = 0.0001). The post-hoc test showed a statistically significant decrease in PTH: measurements 5–8 relative to measurement 1, and measurements 4–8 relative to measurement 2 (p < 0.05). No significant correlations between 25 hydroxyvitamin D3 deficiency, age, diagnosis, SOFA score, and PTH levels were observed. A statistical test indicated that serum concentrations of PTH were significantly higher in the de novo sepsis group (p < 0.05).

Conclusions: The PTH serum concentration decreases during the course of CRRT in the majority of patients. When the course of the disease starts to be complicated by sepsis, PTH serum levels then remain high. A probable reason for this is the existence of the inflammatory state triggered by sepsis.

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Keywords

acute kidney injury; continuous renal replacement therapy; critical illness; intensive care; parathyroid hormone

About this article
Title

Parathyroid hormone serum concentration kinetic profile in critically ill patients undergoing continuous renal replacement therapies: a prospective observational study

Journal

Endokrynologia Polska

Issue

Vol 72, No 4 (2021)

Article type

Original paper

Pages

329-335

Early publication date

2021-04-08

Page views

880

Article views/downloads

320

DOI

10.5603/EP.a2021.0034

Pubmed

34010434

Bibliographic record

Endokrynol Pol 2021;72(4):329-335.

Keywords

acute kidney injury
continuous renal replacement therapy
critical illness
intensive care
parathyroid hormone

Authors

Aneta Czarnik
Ryszard Gawda
Maciej Piwoda
Maciej Marszalski
Maciej Molsa
Marek Pietka
Marek Bolanowski
Tomasz Czarnik

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